Medical Billing Codes

Medical Billing Codes

There are two reasons why medical billing codes were devised for healthcare. First, medical billing codes are used as tools for the settlement of claims for compensation dependent on the codes' ability to communicate information pertaining to diagnostic and therapeutic procedures. In short, they serve as aid to translate doctor's diagnosis and procedures into a language which insurance companies can understand. Second, medical billing codes are devised for clear outcome of data related to the analysis of efficacy of treatment as well as measures of cost effectiveness for underwriters.

One of the standard medical billing codes used in the industry for the past 35 years is the Current Procedural Terminology codes or CPT. CPT medical billing codes have dominated medical billing codes sets for conventional medicine.

CPT medical billing codes were published by the AMA since 1963. According to an article on CPT in JAMA, May 4, 1970, the codes were "developed in response to demands of physicians and agencies for a uniform system of terminology and coding to be used in the reporting of diagnostic procedures and treatment." Since then, the CPT medical billing codes system has continued to grow and evolve to the point of becoming the basis for e-business in conventional medicine.

Medical billing codes are essential to a career in medical billing and coding. They play a very important role in health and behavior assessment of patients. They can capture services addressing a wide range of physical health issues. Such issues include patient adherence to medical treatment, symptom management, health-promoting behaviors, health-related risk-taking behaviors, and overall adjustment to physical illness. In all of these cases, the physician will make a diagnosis of the patient's physical health problem and the diagnoses are then represented by medical billing codes, the ICD-9 CM codes, through the use of the CPT system.

Use of the codes will enable reimbursement for the delivery of healthcare services for an individual whose problem may include physical illness or mental health risks. Physicians who use medical billing codes have a better way of capturing accurately the services provided.

The billing codes have their own assigned relative values. Both are then used for calculating Medicare fees as listed in the 2002 physician fee schedule issued by the Centers for Medicare and Medicaid Services (CMS) in the November 1, 2001 Federal Register.

Each of the codes is based on 15 minutes of service so that means that physician would have to bill 2 units when providing a 30-minute service. When the service falls between units, you must round up or down to the nearest increment.